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Laparoscopic Tubal Anastomosis

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Laparoscopic Approach To An Anterior Lumbar Interbody Fusion At L5-s1 And L4-l5

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Nepomnayshy Dmitry,
Lahey Clinic,
Burlington

PERSONAL COMMENTS:
Even though this is not a widely used approach, it is important to know as an added skill for the lumbar approach surgeon.

ABSTRACT:
The laparoscopic anterior approach for lumbar inter-body fusion (ALIF) was first reported in 1995 and gained early popularity. However, technical challenges and reported complications have recently led to decreased use. Little prospective randomized data exists to definitively support or detract from the anterior laparoscopic approach to the lumbar spine. Some authors have called for the abandonment of the technique. Support for this viewpoint comes from small series which are early in the laparoscopic learning curve. Also, the laparoscopic approach methods were not standardized, potentially leading to further disparity in outcomes.
In many types of abdominal surgery, minimally invasive approaches have lead to reduced complications and earlier return to work. However, in complex procedures, it often requires a large number of cases to develop the necessary skill and then be able to show a benefit to the patient. The lead author, who is a general surgeon specializing in advanced laparoscopic surgery, received additional training to perform laparoscopic exposures of the lumbar spine. He performed thirty procedures before starting the current series. In this video, we show our latest techniques, learned from earlier experience and modified to help reduce complications. The emphasis of this video is on the approach itself.
Laparoscopic restorative proctocolectomy
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